[show abstract][hide abstract] ABSTRACT: To evaluate sleep modifications induced by chronic benzodiazepine (BDZ) abuse.
Cohort study, comparison of sleep measures between BDZs abusers and controls. Drug Addiction Unit (Institute of Psychiatry) and Unit of Sleep Disorders (Institute of Neurology) of the Catholic University in Rome. Six outpatients affected by chronic BDZ abuse were enrolled, (4 men, 2 women, mean age 53.3 ± 14.8, range: 34-70 years); 55 healthy controls were also enrolled (23 men, 32 women, mean age 54.2 ± 13.0, range: 27-76 years). All patients underwent clinical evaluation, psychometric measures, ambulatory polysomnography, scoring of sleep macrostructure and microstructure (power spectral fast-frequency EEG arousal, cyclic alternating pattern [CAP]), and heart rate variability.
BDZ abusers had relevant modification of sleep macrostructure and a marked reduction of fast-frequency EEG arousal in NREM (patients: 6.6 ± 3.7 events/h, controls 13.7 ± 4.9 events/h, U-test: 294, p = 0.002) and REM (patients: 8.4 ± 2.4 events/h, controls 13.3 ± 5.1 events/h, U-test: 264, p = 0.016), and of CAP rate (patients: 15.0 ± 8.6%, controls: 51.2% ± 12.1%, U-test: 325, p < 0.001).
BDZ abusers have reduction of arousals associated with increased number of nocturnal awakenings and severe impairment of sleep architecture. The effect of chronic BDZ abuse on sleep may be described as a severe impairment of arousal dynamics; the result is the inability to modulate levels of vigilance.
Mazza M; Losurdo A; Testani E; Marano G; Di Nicola M; Dittoni S; Gnoni V; Di Blasi C; Giannantoni NM; Lapenta L; Brunetti V; Bria P; Janiri L; Mazza S; Della Marca G. Polysomnographic findings in a cohort of chronic insomnia patients with benzodiazepine abuse. J Clin Sleep Med 2014;10(1):35-42.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2014; 10(1):35-42. · 2.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: Aims
The behavioural-addiction perspective suggests that Internet addiction (IA) and pathological gambling (PG) could share similar characteristics with substance dependence. Despite the similarities between IA and PG, it is not clear whether these disorders share different or similar psychopathological conditions. The aim of the present study was to test whether IA patients presented different psychological symptoms, temperamental traits, coping strategies and relational patterns compared with PG patients. The hypothesis was that IA patients will show greater interpersonal disengagement than PG patients.
Two clinical groups (31 IA patients and 11 PG patients) and a control group (38 healthy subjects) matched with the clinical groups for gender and age were enrolled. The clinical groups were gathered in a psychiatric service for IA and PG in a hospital. Anxiety, depression, coping strategies, attachment, temperament, and global assessment of functioning were measured. MANOVAs, ANOVAs and post-hoc comparisons were carried out in order to test the hypothesis.
Despite IA and PG showing similar differences with the control group on the levels of depression, anxiety and global functioning, the two clinical groups showed different temperamental, coping and social patterns. Specifically IA patients compared with the PG patients showed a greater mental and behavioural disengagement associated with an important interpersonal impairment. The two clinical groups shared an impulsive coping strategy and socio-emotional impairments.
Despite IA and PG patients presenting similar clinical symptoms, IA condition was characterised by a more relevant mental, behavioural, and social disengagement compared to PG condition.
[show abstract][hide abstract] ABSTRACT: Schizophrenia is a brain disease that represents a not rare condition, in fact the lifetime risk of developing schizophrenia is widely accepted to be around 1 in 100. Schizophrenia clinically manifests with acute episodes which are associated with hallucinations, delirium, behavioral disorders and a variable range of chronic persistent symptoms, which can be debilitating. The causes of schizophrenia are not clearly understood. It seems that genetic factors may produce a vulnerability to schizophrenia, along with environmental factors that contribute in a different way from individual to individual. In this context schizophrenia constitutes the outcome of a complex interaction between multiple genes and environmental risk factors, none of which on its own causes the disorder itself. Antipsychotic medications represent the first line of psychiatric treatment for schizophrenia. But there is a growing body of evidence that omega-3 fatty acids can prevent the disease or at least mitigate the course and symptoms. Probably, an appropriate dietary supplementation can play a partially therapeutic effect, even in more severe patients, improving some behavioral aspects and, mainly, reducing the cognitive deterioration. In this context the role of omega-3 fatty acids as a treatment for schizophrenia will strengthen the thrust of researchers and clinicians to the integrated approach to the prevention and cure of a disease that for more than a century challenging researchers.
La Clinica terapeutica 12/2013; 164(6):e529-37. · 0.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: Transient global amnesia (TGA) is a temporary memory loss characterized by an abrupt onset of antero-grade and retrograde amnesia, totally reversible. Since sleep plays a major role in memory consolidation, and in the storage of memory-related traces into the brain cortex, the aims of the present study were: (1) to evaluate changes in sleep macro-structure in TGA; (2) to assess modifications in sleep micro-structure in TGA, with particular reference to the arousal EEG and to cyclic alternating pattern (CAP); (3) to compare sleep parameters in TGA patients with a control group of patients with acute ischemic events ("minor stroke" or transient ischemic attack [TIA]) clinically and neuroradiologically "similar" to the TGA.
TGA GROUP: 17 patients, (8 men and 9 women, 60.2 ± 12.5 years). Stroke or TIA (SoT) group: 17 patients hospitalized in the Stroke Unit for recent onset of minor stroke or TIA with hemispheric localization; healthy controls (HC) group: 17 healthy volunteers, matched for age and sex. Patients and controls underwent full-night polysomnography.
In the multivariate analysis (conditions TGA, SoT, and HC) a significant effect of the condition was observed for sleep efficiency index, number of awakenings longer 1 min, REM latency, CAP time, and CAP rate. TGA and SoT differed only for CAP time and CAP rate, which were lower in the TGA group.
MICROSTRUCTURAL MODIFICATION ASSOCIATED WITH TGA COULD BE CONSEQUENT TO: (1) hippocampal dysfunction and memory impairment; (2) impairment of arousal-related structures (in particular, cholinergic pathways); (3) emotional distress.
Della Marca G; Mazza M; Losurdo A; Testani E; Broccolini A; Frisullo G; Marano G; Morosetti R; Pilato F; Profice P; Vollono C; Di Lazzaro V. Sleep modifications in acute transient global amnesia. J Clin Sleep Med 2013;9(9):921-927.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 09/2013; 9(9):921-7. · 2.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: Sleep state misperception (SSM) is a term used in the International Classification of Sleep Disorders to indicate people who mistakenly perceive their sleep as wakefulness. SSM is a form of primary insomnia. The aim of this study was to record psychological functioning measures (anxiety, depression, ability to feel pleasure, obsessive-compulsive traits) in a population of patients with primary insomnia and to evaluate the relationship between these measures and the patients' perception of their sleep. MATERIALS AND METHODS: Seventy-six consecutive patients with primary insomnia were enrolled: 34 men and 42 women, mean age 53.9 ± 13.1. Sleep study included the following: Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Berlin's Questionnaire and home-based polysomnography. Psychometric evaluation included the following: Self-Administered Anxiety Scale, Beck's Depression Inventory, Maudsley's Obsessive Compulsive Inventory, Snaith-Hamilton Pleasure Scale, Eating Attitude Test. RESULTS: All patients with insomnia had psychometric scores higher than the general population, but very few patients, in both groups, had anxiety or depression scores consistent with severe mood or anxiety disorders. Comparisons between subjective and objective scores confirmed that most sleep parameters were underestimated. Patients with SSM had lower anxiety scores as compared to patients without SSM. CONCLUSIONS: The study did not succeed in identifying any predictor of sleep misperception. We speculate that a group of patients, rather than being extremely worried by their insomnia, may have a sort of agnosia of their sleep.
[show abstract][hide abstract] ABSTRACT: What is known and objective: Prurigo nodularis (PN) is a chronic skin condition that is difficult to treat. Pregabalin is one of the possible treatments for PN but its safety and effi-cacy are not well defined. We aimed to assess the efficacy of pregabalin in patients with PN. Methods: Thirty patients (10 men, 20 women; mean age 51.6 ± 9.39 years) were treated with pregabalin (75 mg/day) for 3 months. Efficacy was classified as (i) successful (disappear-ance of the pruritus and reduction of nodules); (ii) slight improvement/reduction of the nodules, that is, number and/or flattening, no disappearance of itching; or (iii) unsuccessful. Results: Twenty-three patients (76%) responded successfully after 3 months of treatment. There was a statistically signifi-cant difference between visual analogue scale scores before and after 1 month treatment period (8AE15 ± 2AE04 and 1AE5 ± 1AE12, respectively; P < 0AE0001). Pregabalin was generally well toler-ated with only six (20%) patients reporting side effects. No patient showed any renal insufficiency. What is new and conclusion: In our study, pregabalin was effective for the treatment of PN. However, given the open and non-controlled study design used, a properly powered randomized controlled validation study is called for. WHAT IS KNOWN AND OBJECTIVE
Journal of Clinical Pharmacy and Therapeutics 01/2013; 38:16–18. · 2.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: Bipolar disorder is a psychiatric disease that involves profound changes in mood accompanied by severe changes in feelings, thoughts and behaviors: emotions can move quickly from a deep depression to excessive excitement, without some apparent reason. BD is usually a chronic condition and may last for life with recurring episodes that often occur during adolescence or early adulthood, sometimes during childhood and usually requires treatment for life.
In the manic phase the disorder typically occurs in forms of exasperated disinhibition and manic symptoms may include: an euphoric mood or irritable, angry and reactive state of mind; increased activity and feelings of strength and energy; ambitious and grandiose aspirations; poor self-criticism; greater interest in sexual activity and reduction in hours of sleep and need for sleep.
On the other hand, depressive phases may be so serious that can also lead to episodes of self-harm. Depressive symptomatology may include: depressed or apathetic mood; reduced strength in activities, thinking and talking; feeling of being hopeless and helpless; pessimistic approach to reality, sometimes, with suicidal thoughts; alteration in the rhythm of appetite and in sleep patterns.
Although it is not known a definitive cure, BD is a very treatable disease that can be kept under control. Drugs play a key role in the care of persons affected by BD, in particular medications commonly used to treat the manic episodes of bipolar disorder are mood stabilizers. During depressive episodes, people with bipolar disorder can be treated with antidepressants by evaluating administration and dosage with extreme caution because of the risk to switch to a manic phase. In addition to medications psychotherapy and psychoeducational approaches are essential for individuals suffering from bipolar disorder.
At present BD is considered a multifactorial etiology condition in which many physiopathogenetic factors are involved, thus researchers have identified several causes such as biological differences, imbalance of neurotransmitters and hormones, genetic predisposition, traumatic life events, stress and environmental factors.
[show abstract][hide abstract] ABSTRACT: Objectives. In the evaluation of the biological basis of psycho-therapeutic changes many researches have noticed potential effects of psychotherapeutic interventions on the neural correlates of mental illness. In a psychotherapeutic setting, modifications in individual thoughts and feelings can restore brain functioning at physiological levels. This paper gives an overview about neurobiological methods and their potential to support psychotherapy research and to examine psychotherapy effects across a number of psychiatric disorders. Methods. Relevant informations are identified through searches of MEDLINE and Current Contents/Clinical Medicine. Results. Studies demonstrate that it is important to consider putative neural mechanisms of psychotherapy, changes in the brain associated with psychotherapy on a global and molecular level, intervention-specific effects and prediction of outcome. Pharmacotherapy and psychotherapy converge in a common change of neuronal functions that might be detected by imaging techniques and might resemble correlates of clinical improvement. Conclusions. Neuroimaging techniques applied to psychotherapy research are relevant for further understanding neurobiological under-pinnings of psychotherapy processes and predicting treatment outcome in order to improve clinical decision-making and treatment. Clin Ter 2012; 163(6):e445-456 Key words: functional magnetic resonance imaging (fMRI), neural mechanisms, neuroimaging, photon emission computed tomogra-phy (SPECT), positron emission tomography (PET)
La Clinica terapeutica 12/2012; · 0.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objectives. In the evaluation of the biological basis of psychotherapeutic changes many researches have noticed potential effects of psychotherapeutic interventions on the neural correlates of mental illness. In a psychotherapeutic setting, modifications in individual thoughts and feelings can restore brain functioning at physiological levels. This paper gives an overview about neurobiological methods and their potential to support psychotherapy research and to examine psychotherapy effects across a number of psychiatric disorders. Methods. Relevant informations are identified through searches of MEDLINE and Current Contents/Clinical Medicine. Results. Studies demonstrate that it is important to consider putative neural mechanisms of psychotherapy, changes in the brain associated with psychotherapy on a global and molecular level, interventionspecific effects and prediction of outcome. Pharmacotherapy and psychotherapy converge in a common change of neuronal functions that might be detected by imaging techniques and might resemble correlates of clinical improvement. Conclusions. Neuroimaging techniques applied to psychotherapy research are relevant for further understanding neurobiological underpinnings of psychotherapy processes and predicting treatment outcome in order to improve clinical decision-making and treatment. Clin Ter 2012; 163(6):e445-456.
La Clinica terapeutica 11/2012; 163(6):e443-56. · 0.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity. The coexistence of a heart disease complicates the management of mental illness, can contribute to a reduced quality of life and a worse illness course. The co-occurrence of psychiatric disorders in cardiac patients might affect the clinical outcome and morbidity. Moreover, the complex underlying mechanism that links these two conditions remains unclear. This paper discusses the known cardiovascular complications of psychotropic drugs and analyzes the important implications of antidepressive treatment in patients with previous cardiac history.
Journal of Geriatric Cardiology 12/2011; 8(4):243-53.
[show abstract][hide abstract] ABSTRACT: The present research study starts up from the current scientific and academic interest concerning Deficit and Attention/Hyperactivity Disorders, which in this period seems to have an "epidemic" diffusion. Some authors have proved how the Deficit and Attention/Hyperactivity Disorder may predispose to the development of other psychopathological attitude in adulthood. A recent study has underlined a common comorbidity between ADHD in childhood and Bipolar Disorder. The aim of the present was to verify the existence of an ADHD diagnosis in patients with depression (Unipolar and Bipolar) and to verify if such syndrome overstays in the present psychopathological picture. Moreover there has been even the intention to investigate on a difference in ADHD symptomatology in patients with Bipolar and Unipolar Depression.
The study has been conducted on a sample of 67 patients with depression diagnosis (35 patients with bipolar depression diagnosis, 32 patients with depression unipolar diagnosis) enrolled at the Bipolar Disorders Unit of the Clinical Psychiatry and Drug Dependence Institute of the Policlinico Universitario A. Gemelli in Rome. The evaluation has been performed through the supply of the following psychometric tests: Neo Personality Inventory (Mole-pi-R), Brown Attention Deficit Disorder Scale (Brown ADD-Scale), Adult ADHD Self-Report Staircases (ASRS-v1.1), Criteria of the Deficit and Attention / Hyperactivity Disorder for childhood according to the DSM-IV-Tr.
The achieved results point out that 42% of the sample has satisfied the ADHD Criterions during their childhood according to the DSM-IV-Tr and that symptomatology seems to remain in the present psychopathological picture. As to polarity of depression it has emerged that patients with Bipolar Depression diagnosis have satisfied with a greater frequency the ADHD criteria during their childhood than patients with Unipolar Depression.
Our results seem to confirm the hypothesis that patients with bipolar depression diagnosis have more Deficit and Attention / Hyperactivity Disorders comorbidity diagnosis than others.
La Clinica terapeutica 01/2011; 162(2):107-11. · 0.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: Alzheimer's disease (AD) is a degenerative disorder characterized by a decreased regional cerebral blood flow (CBF). It is most likely that a reduction in CBF could displace a pathway leading to AD genesis, in so far neuron death explains a sustained reduction in the supply of oxygen, glucose, and nutrients. Nevertheless, the concept of secondary CBF deficiency cannot explain the critical stages of early memory loss while, on the other hand, the picture of progressive ischemia due to primary CBF decline sheds light on the course of AD in a most persuasive manner. The concept of primary CBF deficiency is even more strengthened by the lack of correlation between degree of dementia and amount of CBF. Vascular abnormalities, frequently observed to co-occur with AD, might play a critical role in the initiation and aggravation of AD pathology given that the elimination of amyloid-β (Aβ) through a vascular route is an important brain Aβ clearance mechanism and its failure leads to formation of vascular amyloidosis and dense-core plaques. The goal of this review is to provide scientists comprehensive knowledge of the state-of the art influence vascular damage and reduced perfusion have on the final development of AD and to hopefully stimulate more research in this area of neuroscience.
[show abstract][hide abstract] ABSTRACT: This review explores the epidemiological evidence for the relationship between depression and cardiovascular disease from a mechanistic standpoint. It is important to examine the biological, behavioral and social mechanisms to improve outcomes for depressed cardiac patients. A number of plausible biobehavioral mechanisms linking depression and cardiovascular disease have been identified. Tricyclic antidepressants have various effects on the cardiovascular system, while selective serotonin reuptake inhibitors are not associated with adverse cardiac effects and should, therefore, be the preferred choice for the treatment of most patients with comorbid depression and cardiovascular disease.
Expert Review of Cardiovascular Therapy 09/2009; 7(9):1123-47.